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36790
CITY OF OSHKOSH N
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC
K PLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS /213 lie,b, a %c t Gam' PLAN NO.
OWNER Ail ,t Ad
DESIGNER
USE /NATURE OF WORK
BUILDING CONTRACTOR
Size Sq. Ft. Rooms Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR l�rc f Electric Serv. New El Change eT mp Type Volts 3 Amps $0
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR
BT WH Disp WSoft CBasin
Lav Sh DW DF San. Sewer
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
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FEES: Valuation P190 0 c9 0 Permit Fee Paid O 0 Park Dedication
ISSUED BY Date 793 Final /O.P.
In the performance of this work 1 agree to perform all work pursuant to rules governing the described construction.
SIGNATURE 7 id
P.3
/OWNER DATE
ADDRESS
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